COVID-19 vaccination in kidney transplant recipients

Abstract

Kidney transplant recipients receive therapeutic immunosuppression that impairs their immune responses to the COVID-19 mRNA vaccine. For this reason, this vulnerable patient population is insufficiently protected by the standard two-dose COVID-19 vaccination programme and requires a specific follow-up to guide personalization of an intensified vaccination approach.

Observations on improving COVID-19 vaccination responses in kidney transplant recipients: heterologous vaccination and immunosuppression modulation

“…Indeed, published rates of seroconversion varies dramatically from 6.4% (4 out of 62) in the study of Chavarot et al 12 , to 41% (5/12) in the report by Kamar et al 13 . These discrepancies could result from differences in confounding variables, especially the association with antiproliferative drugs, usually combined with Belatacept and recognized as risk factor for poor response to mRNA vaccines 14 . To avoid this pitfall, we analyzed in our institutional cohort, the seroconversion rate in KTRs treated with Belatacept having received 3 mRNA doses and matched them with 2 KTRs not receiving Belatacept, on age (+/- 5 years), total lymphocyte count (< 1500/mm 3 ) and use of antiproliferative and steroid drugs.…”

“…Given the crucial importance for kidney transplant recipients to be vaccinated, it has been suggested that Belatacept could be replaced with conventional maintenance therapy to improve vaccine effectiveness 14 . However, whether this strategy is worthwhile deserves further investigation for a number of reasons: (i) recent data has shown that vaccine effectiveness is deeply impacted by pre-existing cross reactive CD4 + T Cells specific for endemic human cold coronavirus 15 , 16 , and (ii) costimulation blockade promotes specific T cell hypo-responsiveness and anergy 17 .…”

Monoclonal Antibody Therapy for SARS-CoV-2 Infection in Kidney Transplant Recipients: A Case Series From Belgium

“…Kidney transplant recipients (KTRs) are particularly vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and may remain at risk after complete vaccination because of poor response rate. 1 , 2 Neutralizing monoclonal antibodies (Abs) have been shown to be safe and efficient in reducing viral load in immunocompetent outpatients with coronavirus disease 2019 (COVID-19). 3 In immunocompromised patients, including solid organ transplant recipients, few reports have reported similar results.…”

Changing of therapeutic trends between the 1st and 2nd wave did not reduce COVID-19 related mortality of renal transplant recipients: a national registry study

“…Accumulating evidence suggests however that KTR have an impaired response to the "standard" 2-dose of mRNA vaccine [44][45][46][47] , which leaves them at high risk of severe COVID-19 46,48 . Despite intensified scheme of vaccination (with third and even a fourth vaccine dose now recommended in weak responders), up to 20% of KTR will not develop sufficient protection against COVID-19 [49][50][51] .…”